Diagnosis clinical criteria of sport related concussion: Toward an operational criteria definition in France.

OBJECTIVE: An expert working group was set up at the initiative of the French Ministry of Sports with the objective of harmonising the management of sport related concussion (SRC) in France, starting with its definition and diagnosis criteria. RESULTS: Definition: A clinical definition in 4 points have been established as follows: Concussion is a brain injury: 1) caused by a direct or indirect transmission of kinetic energy to the head; 2) resulting in an immediate and transient dysfunction of the brain characterised by at least one of the following disorders: a) Loss of consciousness, b) loss of memory, c) altered mental status, d) neurological signs; 3) possibly followed by one or more functional complaints (concussion syndrome); 4) the signs and symptoms are not explained by another cause. Diagnosis criteria: In the context of the direct or indirect transmission of kinetic energy to the head, the diagnosis of concussion may be asserted if at least one of the following signs or symptoms, observed or reported, is present within the first 24hours and not explained by another cause: 1) loss of consciousness; 2) convulsions, tonic posturing; 3) ataxia; 4) visual trouble; 5) neurological deficit; 6) confusion; 7) disorientation; 8) unusual behaviour; 9) amnesia; 10) headaches; 11) dizziness; 12) fatigue, low energy; 13) feeling slowed down, drowsiness; 14) nausea; 15) sensitivity to light/noise; 16) not feeling right, in a fog; 17) difficulty concentrating. CONCLUSION: Sharing the same definition and the same clinical diagnostic criteria for concussion is the prerequisite for common rules of management for all sports and should allow the pooling of results to improve our knowledge of this pathology.

Hereditary neuromuscular disease and multicomposite subjective health status: feasibility, internal consistency and test-retest reliability in the French version of the Nottingham Health Profile, the ISPN.

OBJECTIVE: To evaluate the feasibility, internal consistency and reproducibility of the French version of the Nottingham Health Profile (NHP) completed by adults with hereditary neuromuscular disease. DESIGN: Cross-sectional study with evaluation at 15 +/- 7 days for NHP test-retest. SETTING: Multidisciplinary rehabilitation consultations in Reims. SUBJECTS: Sixty-four neuromuscular disease outpatients completed the NHP consecutively between April 2002 and December 2003. MAIN MEASURES: French version of the Nottingham Health Profile (NHP), Barthel Index and sociodemographic characteristics. RESULTS: The average completion percentages for the different dimensions was 84.2% (range 72-97%). With respect to the completion feasibility of the physical mobility subscale, 7-20% of neuromuscular disease patients failed to complete four items out of eight. In the pain subscale, the same difficulty was encountered for three items out of eight. Internal consistency as assessed by Cronbach's alpha was acceptable for the subscales physical mobility (0.88), emotional reaction (0.74), sleep (0.77), and pain (0.81); it was less reliable for the subscale social isolation (0.61), and poor for the subscale energy (0.47). Test-retest agreement measured by intraclass correlation coefficient was in all instances greater than 0.70. CONCLUSION: Some items in the pain and physical mobility subscales pose problems related to the relevance of the wording for patients confined to wheelchairs. Recoding of the measure makes it possible to avoid missing data from these dependent patients. Scores differ statistically according to the coding used. In study reports, details of such procedures should be provided for comparison of ISPN results with those from other studies in the literature.